Abstract:

Objective To understand the challenges faced by elderly patients with multiple chronic conditions in community settings during the process of disease management，and to provide a basis for developing intervention strategies for managing comorbidities in the elderly. Methods A phenomenological research approach was adopted，using purposive sampling. From July to October 2024，16 elderly patients with multiple chronic conditions from 5 community service centers in Shenzhen were selected as study participants. Semi-structured in-depth interviews were conducted，and the interview data were analyzed using Colaizzi’s seven-step method. Results Totally 4 themes and 8 sub-themes were extracted，including the disorder of multi-source health information structure and environment （insufficient systematic integration of health guidance，uneven quality of knowledge under multiple information channels），the exhaustion of self-management efficacy among chronic disease patients（the coexistence of multiple diseases aggravates the burden of physical and mental symptoms；negative emotions weaken the efficacy of active management），the absence of an integrated management mechanism for multiple diseases（repeated medical visits lead to poor treatment experience；multiple medications pose potential health risks），and the lack of in-depth and dynamic social support practices（formal operation of community support systems，family support facing the dilemma of filial piety and control）. Conclusion Elderly patients with multiple chronic conditions in community settings face numerous challenges in disease management. Current chronic disease management in China primarily focuses on single diseases. It is recommended that healthcare professionals shift their perspective，improve the identification，assessment，nursing，and treatment of comorbidities in the elderly，and provide integrated chronic disease management approaches. This would enable a "one-stop" solution to the management challenges of multimorbidity in elderly patients，thereby enhancing their quality of life.

Key words: Aged, Chronic Diseases, Multimorbidity, Management Challenges, Qualitative Research, Nursing Care

摘要：

目的 了解社区老年慢性病患者在多种疾病管理过程中的困境，为制订老年人多病共存管理干预方案提供依据。 方法 应用现象学研究方法，采用目的抽样法，于2024年7月—10月选取深圳市5所社区卫生服务中心的16例社区老年慢性病共存患者作为研究对象，对其进行半结构式访谈，采用Colaizzi 7步分析法对访谈资料进行分析。 结果 共提炼出4个主题和8个亚主题，分别为多源健康信息结构与环境失序（健康指导系统性整合不足，多元信息渠道下知识质量参差不齐）、慢性病患者的自我应对效能耗竭（多病共存状态加重身心症状负担，负性情绪削弱主动管理效能）、多重疾病整合管理机制缺失（重复就医导致治疗体验不佳，多重用药致使健康安全存在隐患）、社会支持实践缺乏深入性与张力性（社区支持体系形式化运作，家庭支持面临孝道伦理与管理需求的双重张力）。 结论社区老年慢性病患者在多病共存管理过程中面临诸多困境，而目前国内针对慢性疾病的管理仍侧重于单一疾病，建议医护人员应转变观念，提高对老年慢性病共病的识别、评估、护理和治疗水平，提供整合式慢性病管理方法，从而减轻老年患者多病共存管理困境，提升其生活质量。

关键词: 老年人, 慢性病, 多病共存, 管理困境, 质性研究, 护理